Chronic obstructive pulmonary disease : new insights in morning symptons and physical activity

Chronic obstructive pulmonary disease (COPD) is a chronic lung disease, characterised by inflammation and destruction of the airways. There are no curative options yet. However, COPD is a treatable disease, whereby reduction of symptoms is a major treatment goal. In this thesis, we focussed on morning symptoms. The relation between morning symptoms and physical activity was studied in search of novel treatment options. We concluded in a systematic review that there was a negative association between morning symptoms and self-reported physical activity. We confirmed this association in the MOrning symptoms in-Depth observationAl Study (MODAS), an observational cross-sectional study, in which we objectively measured physical activity. We also found that patients with high morning symptom scores took fewer steps in morning and afternoon than those with low morning symptom scores, but not during evening and night. These factors can be used as targets in future interventional studies. A subsequent real life study showed that participating physicians recorded more symptoms and lifestyle advises when a designated approach was used. To pay more attention to morning symptoms and physical activity in clinical practice, we encourage the use of a systematic approach that includes these items.